Let me see if I can offer you some assurances.
Therapy is expensive! I thought it may be helpful to give you an idea what goes into my fee at a one-person, online, private practice.
1. Getting started: Before my graduate program, I had to complete an undergraduate degree with student loans. My graduate program was four years, funded by more student loans, about $50 000. The graduate program included 700 hours or ten months of unpaid work at a community mental health agency. I then had to pay for a professional exam, and begin the path to licensure as an intern. I worked at the lowest pay rate in the industry in order to obtain my requisite 3000 supervised hours. I had to earn less money than fully licensed clinicians. Due to COVID and relocations, my internship took almost four years. During my intern time in Texas, I had to pay for weekly supervision as if in therapy myself.
2. Costs to practice: working from home reduces many overhead expenses, but requires an initial capital layout. Professional equipment and furniture are required. There are monthly utilities, pro rata mortgage costs and expenses such as: an electronic patient portal and virtual delivery service, google business service for HIPAA protected email, online banking, website subscription, therapy database marketing as well as tax accounting services. Any clinician must also carry the costs of applying for and maintaining licensure, obtaining records, maintaining professional indemnity insurance and ensuring annual continuing education credits in training.
3. Training: I do an inordinate amount of training. That is what makes me better at my job. High-end training is expensive because it compensates expert trainers for decades of clinical experience. EMDR, DBT, IFS, Ego State and Clinical Hypnosis trainings are all multi-stage trainings with individual or group consultation hours after the actual training. I belong to multiple consultation teams where I meet face-to-face with an expert for an hour each a week or month. Here I can staff my most difficult cases with very knowledgeable people. This keeps me ethically and legally accountable for your safety. I also attend annual conferences to stay up to date with industry changes. My training is a high-cost item in my practice, and it directly contributes to my specialized experience and distinct qualifications. I buy more books on therapy and treatment than I have place to store.
4. Invisible labor: I spend much more time maintaining my practice than I can charge money for. A lot of personal time is devoted to managing my client schedule after hours, responding to inquiries and messaging. I also have to maintain assessment and progress records for each client, including record of communications between sessions. Clients sometimes require my help with documentation or billing for which I do not charge. I spend a significant amount of time marketing my practice. I offer consultation on my specialty to other therapists for free. I maintain my website with updated information about my practice, which can take hours at a time. I sometimes make resources available to clients. I have to prepare before each session, show up well in advance, and make sure I am appropriately dressed and organized. Our time together has not even started! My labor in session reflects the emotional and intellectual work of being entirely, 100% engaged in the details of your life. My fee also reflects the time it takes me to recover from the burden of this kind of work.
5. Market norms: My fees are not out of proportion to what clinicians in the local market charge. Although this may not feel comforting, it is ultimately in your interest that my fees do not drastically undercut my colleagues. A stable market keeps services available to all consumers. Therapists will simply stop providing mental health services when they can no longer make a living. Those who ask a very low fee may have a second income through a partner, or little clinical experience. Asking too low fees pushes others out of the market. I try to compensate for high market rates by offering a special fee accommodation to 10% of my caseload. For instance, if I have about 25 clients on my case load, I can offer at least two clients the therapy fee that they can afford. Yes, you read that right. If you earn minimum wage, I only charge you what you earn in one hour of work. Unfortunately these spots do not become available very often. If you want to get on my waiting list for this fee accommodation, please send me an email. I would love to keep your name until I can make the same offer to you.
6. Background: My practice does not solely rest on my education and training. I entered this profession as my third career, and bring prior professional skills to my current work. This distinguishes me from someone who has only studied and worked in this one field. I studied law for six years in South Africa, I practiced law as a public defender and I completed a Master's degree in International Economic Law. I learned to research and litigate in front of judges and other lawyers. I also taught college-level English in Korea for many years, and studied for five years to obtain my PhD in English Literature. I learned to be a softer individual in helping students, but even better at academic research and critical thinking. I am a more mature counselor because of this background. I also have a personal journey in my own mental health that contributes to my genuineness in therapy. Your fee gets you all of that.
I accept all the insurance partners of Alma (www.helloalma.com)
The following commercial insurance companies participate (are in-network) with Alma’s insurance program:
Optum is inclusive of several health plans that Alma does not currently accept, including:
Aetna is inclusive of several health plans that Alma does not currently accept, including:
You always have the right to cancel therapy or reschedule a session without giving me an explanation. However, I require 24-hours notice if you need to change your appointment and avoid a full-session charge. I get that it is not always possible to have 24-hours notice available. This cancellation policy is not intended to punish you. It is intended to compensate me for having a private practice. I run my business in good faith that you will attend, I offer you a slot on my schedule before you pay, and you can trust me to protect your reservation. If you do not show up, I still have to carry the operating costs of this business model. Although you only rarely need to cancel or experience an emergency, I have multiple clients in that position every week. I regret not granting you the favor of simply missing a session, but I won't be able to make a living that way.
Let's be honest, talk therapy is only one pathway to healing and wellness. If I think you will benefit more from something outside my scope of practice, I am going to let you know! Here's how talk therapy can help: it helps you overcome the avoidance of internal experience, it helps you articulate that experience, it permits integration of new learning and actively promotes the rewiring of your brain. It heals attachment wounding through attention and attunement. It also uses modalities that can actively help the brain heal from wounding and damaging life experience. I do this work with my life because I have seen it change people's lives.
Clients typically worry that telehealth will not feel as intimate or real as in-person therapy. I get why that seems true. However, experience has taught us all differently. What everyone wants, is a genuine connection. I genuinely care. My clients feel that, and it makes all the difference to them. At that point, technology seems like a convenience. Online therapy is so much safer and more accessible than in-person therapy. It makes a tremendous difference when you work long hours, or leaving the house horrifies you. It also means you can get treatment regardless of where you live. Telehealth is not appropriate is you do not have a stable Internet connection, or struggle with staying focused in front of a screen.
Therapy should not take forever. There, I said it! At some point, treatment must reach the end of its purpose. This means you should always be mentally prepared to successfully complete therapy. If therapy has no plan and no end, talking becomes conversational. It can easily begin to feel like a paid friendship, create dependence and blur boundaries. After you have reached your therapy goals, you may choose to use therapy for check-in purposes. I welcome long-term therapy once a month or a few times a year when an issue shows up.
Martha Graham
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